[Development, implementation, and analysis of a "collaborative decision-making for reasonable care" document in...

Area of Science:

• Pediatric Palliative Care
• Medical Ethics
• Healthcare Management

Background:

• French law mandates collaborative decision meetings and documentation for decisions to limit treatments (DLT).
• Do-not-attempt-resuscitation (DNAR) orders for children in palliative care follow similar decision-making processes.
• A dedicated document was developed to standardize DLT decision-making and improve communication across pediatric units.

Purpose of the Study:

• To evaluate the implementation and relevance of a new traceable document for DLT.
• To analyze the decision-making process and quality of information transmission.
• To assess the document's impact on communication with families and continuity of care.

Main Methods:

• Retrospective study analyzing 58 completed data sheets from January to December 2013.
• Data collected focused on evaluating item relevance, document transmission, patient profiles, and family discussions.
• Analysis included data from various pediatric units, including intensive care, oncology, hematology, neonatology, neurology, and pneumology.

Main Results:

• 58 data sheets were collected, primarily from pediatric intensive care (41).
• Decisions involved withholding (39) or withdrawing (11) life-saving treatment; 9 children survived after DLT.
• Family discussions were documented in 53% of cases; the document was transmitted to new units for 79% of transferred children.

Conclusions:

• The document demonstrates value in standardizing DLT processes and improving data transmission and care continuity.
• Its creation and presentation across units were crucial for adoption.
• While improving clinical description and care planning, enhancing family communication and systematic transcription remains an area for development.